Universal Coverage – A Call For Action

Whitney W. Addington, M.D., F.A.C.P.
President, American College of Physicians-
American Society of Internal Medicine
“Universal Coverage – A Call For Action”
National Coalition on Health Care Leadership Summit
The Carter Center, Atlanta, Georgia
January 26, 2000

Thank you. Let me first extend my gratitude to the National Coalition on Health Care for organizing this event. I am profoundly honored to be here this morning in the presence of former President Carter and the other distinguished panelists.

Please allow me to make a few comments on why the issue of the uninsured has become such an important priority for the College. Central to the mission of my College is caring for patients. Physicians have been watching an epidemic grow in this country that now affects over 44 million people. The disease? A lack of health insurance. Being uninsured constitutes a terrible health risk. The College has taken a series of steps to address this epidemic – our latest effort is to undertake the most thorough literature search to date on the subject to document, once and for all, the dangers of going without health insurance in America.

At the outset, let me say that I do not think the drive for universal health insurance is unrealistic. I think the time for finding a solution to this problem has never been more promising.

First, I do not think Americans are hard-hearted. Quite the contrary, we lead the world in voluntary charitable contributions. We are always quick to help our neighbors and even those outside our borders in the case of natural disasters or other tragedies.

Likewise, we are an action-oriented people. When the dangers of tobacco use became apparent, we took action to teach people, especially children, of its hazards. The number of smokers in this country has been drastically reduced. When we found that the use of seat belts saves lives, we undertook an aggressive education campaign to underscore their value and made their use mandatory.

Why then, have the American people allowed the number of uninsured to grow to more than 44 million and that figure continues to rise at the rate of 100,000 per month?

I think the reason can be summed up in one word – myth.

Too many Americans believe the myth that no one in this country who really needs medical attention is denied it. They believe free clinics abound and emergency rooms are always on hand to provide free care.

Many confuse emergency intervention situations with the continuity of quality care that insured patients receive. Most doctors continue providing care to patients when they lose their insurance. The evidence shows that uninsured people are more likely to delay getting needed care. They are likely to forego screening tests, such as mammograms, let prescriptions go unfilled, and neglect follow-up care needed to effectively treat illnesses.

In short, the care the uninsured receive is fragmented, spotty, and is often for conditions that could have been prevented in the first place by an earlier visit. Many studies find that being uninsured, regardless of income presents a serious health risk-although it is certainly true that uninsured poor people face the greatest risk.

These kinds of dangerous myths are, in my mind, what has frustrated universal health coverage in this country. There is no doubt in my mind that, if the majority of Americans knew about the dangers of being uninsured, they would demand immediate action from their elected lawmakers.

I was quite please to recently read President and Mrs. Carter’s book, Everything to Gain in which the plight of this nation’s health care system is discussed with their usual grace and seriousness of purpose. The Carters talk in their book about how health problems drew their childhood communities together. They write, “we shared the pain and suffering of our neighbors and when someone had a really serious illness, neighbors and friends would join family members in something like a death watch when crisis approached.” I am hopeful that this nation can gather together in a time of great need-as the rolls of the uninsured grow every day-and tackle this fundamental need of our friends, neighbors and family.

This brings us to our study. Our research staff culled through over 1000 studies to identify the more than 100 described in our paper, “No Health Insurance? It’s Enough to Make You Sick.”

The conclusions are disheartening and unfortunately not surprising. Among the major conclusions we found:

• Uninsured Americans miss or delay care resulting in unnecessary sickness, death and greater severity of illness. Delays in seeking care are particularly important for diseases, such as cancer and diabetes, for which diagnosis and treatment during early stages may prevent further complications and prolong survival.
• The uninsured use more expensive treatment for preventive, acute and chronic care because they often obtain their primary medical care in the emergency department rather than in a physician’s office. Non-urgent cases accounted for more than 50% of the 90 million visits to U.S. hospital emergency departments in 1992. These increased costs are absorbed by providers, passed on to the insured via cost shifting and higher health insurance premiums, or paid by taxpayers through higher taxes to finance public hospitals and public insurance programs.
• The uninsureds’ inability to take advantage of preventive care also increases the nation’s healthcare costs. Uninsured pregnant women seek prenatal care later in the pregnancy, if at all. This increases the probability that care for the newborn will occur in a neonatal intensive care unit.
• Failure to detect and treat hypertension increases the likelihood of hospitalization and care in the intensive care unit for stroke, heart attack, or congestive heart and kidney failure. Failure to prevent these complications results in increased costs of medical care and loss of productivity.

In summary,

• Uninsured Americans are three times more likely than insured individuals to experience adverse health outcomes.
• Uninsured Americans have been found to be four times as likely as insured patients to require both avoidable hospitalizations and emergency hospital care.
• Uninsured Americans experience higher mortality.

Some of the more compelling statistics from the report include:

• Uninsured children are up to 40% less likely to receive medical attention for a serious injury than those who are insured.
• Uninsured women with breast cancer have a 49% higher adjusted risk of death.
• Uninsured Americans are up to 3.2 times more likely to die in the hospital.
• Uninsured Americans, compared to the insured, are more likely to experience an avoidable hospitalization for asthma.
• Uninsured Americans are up to 2.8 times more likely to experience an avoidable hospitalization for diabetes.

In short, uninsured Americans tend to live sicker and die earlier than insured Americans. Our hosts, the Carters, have known this for quite some time. In their book, they list nine major causes of unnecessary sickness and premature death in our country that have the greatest potential for being prevented. On the list of preventative measures we can take to manage our life span was regular check-ups including blood pressure screening tests. A simple check-up is rare for someone unfortunate enough to be in the uninsured population.

In conclusion, we hope this report serves as a wake-up call for the American public that something has to been done to reduce the number of uninsured in this country. The College has begun a $1 million public relations campaign to make this report’s findings known.

We are now living in an era of unprecedented prosperity. If we can’t afford to create a system of universal health care now, when can we? Therefore, we are calling on all presidential and congressional candidates to commit to propose or act on a plan, within their first year in office that will result in all Americans having affordable health insurance coverage. Our economy is booming, we have the money, all we lack is the will.

Regarding the uninsured, let the American people ask their elected leaders, if not you, who? If not now, when?

Thank you.